Tennis
Music
Register online at hpparks.org
1 YOUR INFORMATION
Family's Last Name: ______________________________________________________________ Address: _________________________________________________________________________ Mother's Name: __________________________________________________________________ City:__________________________________________________________ Zip: ______________
Father's Name: ___________________________________________________________________ Home Phone: (________) __________________________-_______________________________ E-mail: ____________________________________________________________________________ Cell Phone: (________) _________________________-_________________________________ 2 REGISTRATION Participant’s Name
Birth Date
Tennis Grade Male or Female
Music
Program Name
Program #
Fee
Tennis Total Due $ SPECIAL ACCOMODATIONS / A.D.A Participant's Name: ___________________________________________________________________ Program Number: ____________________________________________________________
Music
Tennis
Please list any medications currently being taken or describe special accomodations needed for successful inclusion into the program(s). _____________________________________
3 WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK
Please read this form carefully and be aware that in signing up and participating in the programs listed above, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with said programs/activities (including transportation services/vehicle operation, when provided). I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all
Tennis
volunteers and employees (hereinafter collectively referred to as 'Hanover Park Park District"). I do hereby fully release and forever discharge the Hanover Park Park District from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with these programs/activities. By signing, you signify that you have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. After reading the above information, please sign and date the Registration Form. PHOTO POLICY The Hanover Park Park District reserves the right to photograph or videotape participants in Park District programs, facilities or parks for the District's use.
Name:______________________________________________________
Signature:_________________________________________________
4 METHOD OF PAYMENT - FEES DUE AT TIME OF REGISTRATION
Help build a better tomorrow!
CASH - Do not mail cash. Walk-in registration only. CHECK/ MONEY ORDER - Please make payable to the Hanover Park Park District. Mail-in, Drop-off or Walk-in registration.
Circle One:
Tennis
CREDIT CARD - Please complete the credit card payment information below. Fax-in, Mail-in, Drop-off or Walk-in registration.
Card Number______________________________________________ Exp. Date ___________ Amount of Payment $_____________________ Billing Zip Code _____________________ Authorized Signature ____________________________________________________________
Date:_____________________
I would like to make a contribution to the Hanover Park Park Foundation to assist in providing recreation opportunities for the youth of the Hanover Park Park District.
I would love to donate! 5 SUBMIT
$5
$10
$20
Tennis
Participant's
Music
PARTICIPATION WILL BE DENIED if the signature of adult participant or parent/guardian and date is not on the waiver. I have read and fully understand the important information, warning and risk, assumption of risk and waiver and release of all claims on this form.
OTHER $_________
